I had radial keratotomy surgery in 1995, and my vision has regressed, with significant fluctuations in my vision from morning to night. What are my options? -- Doug Wagner, Sherman, Ill.
You can have surface PRK with good results but these vision fluctuations will most likely continue. Called diurnal variation, these vision changes are very common with RK and unheard of with Lasik.
RK, performed in the '80s and early '90s, used a blade to make a series of incisions radiating from the center of the cornea. The procedure turned out to be unstable and most RK patients end up with blurred vision for both near- and far sight. Some of the RK eyes eventually stabilize but some keep changing, so the PRK can be repeated again if necessary. I no longer like to do LASIK in RK eyes because it is riskier, because you have these incisions from the original RK surgery to deal with. The Lasik flap would have to cut through these RK incisions and it's a complication you'd rather not have to deal with.
If you have had radial keratotomy and cataract surgery, can you still have the Lasik eye surgery? -- Joyce Beshears, Fort Smith, Ark.
Yes. The best option would be to have PRK to get the vision you want.
People who've had RK and then have cataract surgery to replace their cloudy lens have a greater chance of getting an inaccurate lens implant, i.e. the implant doesn't correct the vision to the degree desired. But we don't like going back into the eye to replace the implant. It's less risky to fix the difference with PRK or Lasik.
Is all-laser Lasik surgery safe for glaucoma patients and people at risk for glaucoma? Is glaucoma more difficult to manage after Lasik? -- Mary King, Brant Lake, N.Y.
It can be safe to do unless there is already a lot of optic-nerve damage. The glaucoma can be managed but the pressure reading by the doctor has to be adjusted after LASIK or PRK as the pressure tends to read lower than it actually is.
Is laser surgery ever covered by insurance? -- Donna Fitchett, Yakima, Wash.
No, because it is rarely medically necessary.
How safe is Lasik? -- Kathy Pelham, Issaquah, Wash.
It is probably one of the safest surgeries ever developed, but it is still surgery and carries a small risk of serious complications. The most serious complication would be an infection under the Lasik flap. If it's a minor infection and not in the center of the cornea, we treat it with antibiotics and there's usually no permanent damage. In rare cases, when the infection is in the center of cornea, and it's a particularly virulent bug, it can be more difficult to control and the infection can leave scarring and your vision will be blurred. At that point, you'll have to have a cornea transplant to fix the blurring, but that happens in about one in 100,000 cases. It's pretty rare.
